Fraud is an increasingly recognised problem in clinical trials, and also a matter of concern for healthcare insurance claims and reimbursement. Fraud involves submitting details of fictitious subjects, or data from subjects that exist, but for which all or part of the data submitted was not collected from the correct subject or not collected at the right time or has been deliberately modified in some undeclared way. With the increasing use of images in clinical trials and in healthcare, the impact fraudulent images may have is a significant cause for concern.